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NPI Code Detail

MEDICARE: MOSES NIMO PHARMACIST

MEDICARE: MOSES NIMO PHARMACIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist19381OK

General Provider Information

NPI Number : 1225707276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOSES NIMO PHARMACIST
Provider Business Mailing Address
First Line : 4414 W MADISON PL
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-8542
Country : US
Telephone Number : 918-406-0826
Fax Number :
Provider Business Practice Location Address
First Line : 5046 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74145-5714
Country : US
Telephone Number : 918-627-6464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2021
Last Update Date : 09/12/2021

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Directions to “ MOSES NIMO PHARMACIST” Practice Location

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